Microvascular skin coverage in wounds that expose the Achilles tendon

Achilles tendon rupture is one of the most frequent tendon ruptures. Surgical intervention is the best option, but it has a high rate of complications leading to skin infections and necrosis. Extensive and aggressive debridement is necessary, producing tendon exposure and large skin defects. There are many alternatives for the skin coverage of the Achilles tendon, like sequential closures, vacuum assisted closure, local flaps, regional flaps, and more recently and efficiently microsurgery flaps. Skin defects in the Achilles tendon region have many peculiarities in comparison with other parts of the body: it is a zone that is always under mechanical stress due to footwear, this is why it must be highly resistant but thin. Its coverage must have sensitive properties, endure tendon gliding and allow early rehabilitation. Sometimes tendon reinforcement or creation or a neo tendon will be needed. For fulfilling these requirements free flaps by microsurgery are the only option in 90% of the cases. In this review article, we analyze three of the most frequently used free flaps in reconstructive medicine for complex Achilles tendon defects; free radial forearm flap, free radial forearm flap with vascularized flexor carpi radialis tendon and free anterolateral thigh (ALT) flap with vascularized fascia lata. This choice will be determined by the number of tissues involved, size of the defect, etiology of the defect, overall condition of the affected extremity and quality of neighboring tissues.

1246 Partial Phalloplasty After Oncologic Resection: A Challenge for Health Centers in Remote Area of Indonesia

Background Restoring penile function for urination and sexual activity, and achieving cosmetic result, are the goals of penile reconstruction including in post-malignancy reconstruction. Lack of studies has reported the usage of radial forearm flap on partial phalloplasty. Case Presentation A 31-years old male presented with fragile, cauliflower-like mass sizing 6x8 cm. The tumor had covered whole glans until the middle shaft of the penis. Plan of treatment for this patient started with complete excision of the tumor (partial penectomy), continued with phalloplasty. Phalloplasty consisted of using radial forearm flap (RFF) for penile foreskin (including glans), reconstructing corporal bodies using sartorius muscle, reshaping the penile glans, and urethroplasty to correct the hypospadic-looking urethra. Radial forearm flap of the non-dominant arm was implanted on the remaining foreskin of the penis, continued with wound care. On the 7th day postoperatively, no signs of necrotic, wound dehiscence, nor pus were observed, with capillary refill time on the distal fingers shown less than 2 seconds. Further evaluation is scheduled. Conclusions Loss of physiologic function usually follows partial penilectomy, which could lead to decrease in psychological quality of life. The main goal of the reconstruction of penile foreskin (including glans) using RFF is to form a newly formed penile glans that would have a cosmetic appearance nearly similar to a normal glans, which could improve its physiologic function and benefit psychologically. A challenge for health care centers in remote is is how to monitor and maintain a viable flap after the reconstruction and to keep a regular evaluation from the patient.

Cephalic Vein Supercharging to Prevent Venous Congestion for a Reverse Radial Forearm Flap Used in the Reconstruction of Dorsum of Hand: A Case Report

The reverse radial forearm flap is often co-opted for soft tissue reconstruction of the dorsum of hand. Venous congestion can lead to flap necrosis or failure. To improve dorsum hand reconstruction outcomes, sufficient venous drainage is very important. In this case report, we discuss the situation of a 66-year-old male patient with a serious degloving injury on the dorsum of his right hand. After reverse radial forearm flap adaptation, venous anastomosis between the cephalic vein and the dorsal superficial vein was performed prophylactically and the patient recovered well without congestion or complications. We implemented venous supercharging, which is a relatively easy and simple procedure, to prevent venous congestion. The success of the procedure shows that venous supercharging can aid in the prevention of venous congestion.

Two-Stage Prelaminated Mucosal Neourethra Radial Forearm Flap Phalloplasty for Transgender Men

Background: Our goal in the construction of the transman phalloplasty is not only to decrease the patient’s level of gender dysphoria, obviate the use of an external prosthesis, give the patient the ability to urinate in the standing position and orgasm but also to decrease urinary complications. Material and Methods: A retrospective review of transmen patients from June 2016 to June 2018 was performed on patients undergoing a two- stage mucosa only prelaminated neourethra radial forearm flap phalloplasty. The surgical technique is detailed in addition to patient demographics including co-morbidities, flap complications, and urinary sequelae.